Neonatal fungemia: a case series highlighting the threat posed by non-albicans Candida (NAC) species and a yeast-like filamentous fungus
摘要
Neonatal fungemia represents a substantial contributor to morbidity and mortality in 25–30% of neonatal intensive care units (NICUs), particularly affecting preterm or low-birth-weight infants. The immune systems of neonates, particularly those who are preterm, are underdeveloped, making them highly susceptible to infections like fungemia.
CasesIn the neonatal intensive care unit (NICU), bloodstream infections (BSIs) were identified in 18 out of 72 cases, accounting for 25% of the total. Of these, five cases were attributed to fungal infections, constituting 27.7% of all infections over the past three months. This report concentrates on these five neonatal cases, which were diagnosed with fungemia, a form of bloodstream infection caused by Candida and yeast-like filamentous fungi, particularly affecting newborns. The non-albicans Candida (NAC) species, specifically Candida tropicalis, Candida krusei, and Candida pelliculosa, as well as the arthroconidial yeast-like filamentous fungus Saprochaete capitata, have been associated with increased morbidity and mortality rates. A significant proportion of these cases were outborn, with potential associations to risk factors such as maternal vaginal candidiasis or lapses in infection control measures during childbirth. All cases were identified within the first week of life and were consequently classified as early-onset neonatal sepsis. In addition to maternal risk factors, several neonates were delivered preterm, exhibited low birth weight, experienced respiratory distress, and required ventilatory support. Unfortunately, only two cases resulted in recovery and discharge, while the remaining three did not survive.
Discussion & ConclusionsThe prompt identification and management of conditions are essential for optimizing patient outcomes. This study highlights the critical role of non-albicans Candida species and other yeast-like invasive fungi as key factors in the onset of early neonatal sepsis within neonatal intensive care units (NICUs).